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Postoperative radiotherapy for oral cavity cancers: Impact of anatomic subsite on treatment outcome
251
Abstracts from international literature C a n c e r in neck nodes with u n k n o w n p r i m a r y site: role of mucosal radiotherapy c. s. Harper, W. M. Mendenhall, J. T. Parsons, S. R Stringer, N. J. Cassisi, R. R. Million Head Neck 1990: 12: 463-9.
Sixty-nine patients with metastatic squamous cell carcinoma in neck nodes with an unknown primary lesion were treated with curative intent between October 1964 and December 1986. Sixtyfive patients received radiotherapy to the neck and at least past of the mucosa of the head and neck, whereas 4 patients received treatment to the neck only. Mucosal doses were approximately 5,000 cGy-6,000 cGy at 170 cGy-180 cGy per fraction. Eight patients (12%) subsequently developed mucosal site failures, a figure that did not differ significantly from the incidence of a second metachronous head and neck cancer following definitive irradiation in a series of 393 patients with lesions of the supraglottic larynx, pharyngeal wall, pyriform sinus, or tonsillar area. This suggests that radiotherapy was highly effective in preventing the appearance of cancer at the unknown primary site from which the neck metastasis arose. Absolute and cause-specific 5-year survival rates were 48% and 66%, respectively. H. TIDEMAN
of the study was to determine the impact of anatomic subsite on the results of treatment. Between 1975 and 1985, 51 patients with squamous cell carcinoma of the oral tongue (OT = 29 patients) and floor of mouth (FOM = 22 patients) were treated with combined surgery plus RT. All had an indication(s) for RT including advanced primary disease (T3 or T4) (29 patients), close or positive margins (34 patients), and multiple positive neck nodes and/or extracapsular extension (41 patients). With a median follow-up of 6 years, the 5-year actuarial local control rate was 74% and the rate of distant metastasis (DM) was 34%. Despite the similar T stage, margin status and median RT dose, the 5-year actuarial local failure rate was 38% for OT vs. 11% for F O M ( p = 0.03). Furthermore, the median survival after recurrence was 9 months for OT and 40 months for F O M (p = 0.02). At 5 years the determinate survival for both sites was (55%), and the likelihood of developing a second malignancy was 31%. The likelihood of developing D M was 50% for F O M (N0-N1 = 3 of 12, N2-N3 = 8 of 10) and 21% for OT (N0N l = 4 of 21, N 2 - N 3 = l of 8 ) . This study highlights significant differences between F O M and OT cancers in response to combined surgery and RT. Future strategies should be directed at the enhancement of local control for OT and better systemic therapy for those with advanced N-stage FOM. Second primary cancers were an even greater threat to survival than anticipated. H. TIDEMAN
P o s t o p e r a t i v e r a d i o t h e r a p y for oral cavity cancers: i m p a c t of a n a t o m i c subsite on t r e a t m e n t outcome
M o d i f i e d radical neck dissection in c a n c e r of the mouth, p h a r y n x , and larynx
M. J. Zelefsky, L. B. Harrison, D. E. Fass, J. Armstrong, R. H. Spiro, J. P. Shah, E. W. Strong
R. A. Khafif, G. A. Gelbfish, D. K. Asase, P. Tepper, J. N. Attie
Head Neck 1990: 12: 470-5.
Head Neck 1990: 12: 476-82.
The authors have retrospectively reviewed the treatment results of postoperative radiotherapy (RT) for advanced oral cavity cancers. The purpose
A retrospective analysis of 390 determinate radical neck dissections ( R N D ) performed for cancers of the mouth, pharynx, and larynx was carried out.
There were 75 patients (19%) who had a modified RND. These were separately analysed and the outcome was compared with those who had a standard total RND. The goal of the authors was to assess the effectiveness of modified R N D in controlling disease in the neck, and to identify its impact on survival and quality of life. Overall neck recurrence rate in the entire modified R N D group was 28%, 35% in the partial RND, and 25% in the comprehensive modified RND. Neck recurrence rate was no worse in the comprehensive modified R N D for NO and N1 cases, but increased significantly (compared with the group of patients with standard R N D ) in the N2 and N3 cases (52% vs. 33 %). Treatment of neck recurrences following modified R N D was primarily by surgery, with a 48% 3-year diseasefree survival. Overall survival was the same for modified R N D (68%) and for standard total R N D (63%). This was true for all N stages individually. The morbidity of standard total R N D is discussed and the goals of modified R N D are analysed. Definitions and a standardized nomenclature for the various types of modified R N D are suggested for uniformity of reporting. H. TIDEMAN
Intraoral a d e n o i d cystic c a r c i n o m a . The p r e s e n c e of p e r i n e u r a l s p r e a d in relation to site, size, local extension, and m e t a s t a t i c s p r e a d in 22 c a s e s J. E. van der Wal, G. B. Snow, I. van der Waal Cancer 1990: 66: 2031-3.
Twenty-two patients with an intraoral adenoid cystic carcinoma (ACC), initially treated by surgery with or without postoperative radiotherapy, were examined for the presence of perineural spread in relation to primary site, size, local extension, histologic status of the surgical margins, and metastatic spread of the tumor. There seems to be no c o t -
Abstracts from international literature C a n c e r in neck nodes with u n k n o w n p r i m a r y site: role of mucosal radiotherapy c. s. Harper, W. M. Mendenhall, J. T. Parsons, S. R Stringer, N. J. Cassisi, R. R. Million Head Neck 1990: 12: 463-9.
Sixty-nine patients with metastatic squamous cell carcinoma in neck nodes with an unknown primary lesion were treated with curative intent between October 1964 and December 1986. Sixtyfive patients received radiotherapy to the neck and at least past of the mucosa of the head and neck, whereas 4 patients received treatment to the neck only. Mucosal doses were approximately 5,000 cGy-6,000 cGy at 170 cGy-180 cGy per fraction. Eight patients (12%) subsequently developed mucosal site failures, a figure that did not differ significantly from the incidence of a second metachronous head and neck cancer following definitive irradiation in a series of 393 patients with lesions of the supraglottic larynx, pharyngeal wall, pyriform sinus, or tonsillar area. This suggests that radiotherapy was highly effective in preventing the appearance of cancer at the unknown primary site from which the neck metastasis arose. Absolute and cause-specific 5-year survival rates were 48% and 66%, respectively. H. TIDEMAN
of the study was to determine the impact of anatomic subsite on the results of treatment. Between 1975 and 1985, 51 patients with squamous cell carcinoma of the oral tongue (OT = 29 patients) and floor of mouth (FOM = 22 patients) were treated with combined surgery plus RT. All had an indication(s) for RT including advanced primary disease (T3 or T4) (29 patients), close or positive margins (34 patients), and multiple positive neck nodes and/or extracapsular extension (41 patients). With a median follow-up of 6 years, the 5-year actuarial local control rate was 74% and the rate of distant metastasis (DM) was 34%. Despite the similar T stage, margin status and median RT dose, the 5-year actuarial local failure rate was 38% for OT vs. 11% for F O M ( p = 0.03). Furthermore, the median survival after recurrence was 9 months for OT and 40 months for F O M (p = 0.02). At 5 years the determinate survival for both sites was (55%), and the likelihood of developing a second malignancy was 31%. The likelihood of developing D M was 50% for F O M (N0-N1 = 3 of 12, N2-N3 = 8 of 10) and 21% for OT (N0N l = 4 of 21, N 2 - N 3 = l of 8 ) . This study highlights significant differences between F O M and OT cancers in response to combined surgery and RT. Future strategies should be directed at the enhancement of local control for OT and better systemic therapy for those with advanced N-stage FOM. Second primary cancers were an even greater threat to survival than anticipated. H. TIDEMAN
P o s t o p e r a t i v e r a d i o t h e r a p y for oral cavity cancers: i m p a c t of a n a t o m i c subsite on t r e a t m e n t outcome
M o d i f i e d radical neck dissection in c a n c e r of the mouth, p h a r y n x , and larynx
M. J. Zelefsky, L. B. Harrison, D. E. Fass, J. Armstrong, R. H. Spiro, J. P. Shah, E. W. Strong
R. A. Khafif, G. A. Gelbfish, D. K. Asase, P. Tepper, J. N. Attie
Head Neck 1990: 12: 470-5.
Head Neck 1990: 12: 476-82.
The authors have retrospectively reviewed the treatment results of postoperative radiotherapy (RT) for advanced oral cavity cancers. The purpose
A retrospective analysis of 390 determinate radical neck dissections ( R N D ) performed for cancers of the mouth, pharynx, and larynx was carried out.
There were 75 patients (19%) who had a modified RND. These were separately analysed and the outcome was compared with those who had a standard total RND. The goal of the authors was to assess the effectiveness of modified R N D in controlling disease in the neck, and to identify its impact on survival and quality of life. Overall neck recurrence rate in the entire modified R N D group was 28%, 35% in the partial RND, and 25% in the comprehensive modified RND. Neck recurrence rate was no worse in the comprehensive modified R N D for NO and N1 cases, but increased significantly (compared with the group of patients with standard R N D ) in the N2 and N3 cases (52% vs. 33 %). Treatment of neck recurrences following modified R N D was primarily by surgery, with a 48% 3-year diseasefree survival. Overall survival was the same for modified R N D (68%) and for standard total R N D (63%). This was true for all N stages individually. The morbidity of standard total R N D is discussed and the goals of modified R N D are analysed. Definitions and a standardized nomenclature for the various types of modified R N D are suggested for uniformity of reporting. H. TIDEMAN
Intraoral a d e n o i d cystic c a r c i n o m a . The p r e s e n c e of p e r i n e u r a l s p r e a d in relation to site, size, local extension, and m e t a s t a t i c s p r e a d in 22 c a s e s J. E. van der Wal, G. B. Snow, I. van der Waal Cancer 1990: 66: 2031-3.
Twenty-two patients with an intraoral adenoid cystic carcinoma (ACC), initially treated by surgery with or without postoperative radiotherapy, were examined for the presence of perineural spread in relation to primary site, size, local extension, histologic status of the surgical margins, and metastatic spread of the tumor. There seems to be no c o t -